The Modified Latissimus Dorsi Flap: Anatomic Study And Clinical Application

Objective To investigate the anatomic study and the result of clinical application about modified latissim dorsi flap without excising thoracodorsal nerve based on anatomic study.Methods①Sixteen human cadavers(32 sides) were selected.Thoracodorsal nerves and thoracodorsal arteries were observered through microdissection.②A imitative operation of the thoracodorsal artery musculocutaneous perforator flap(TAMPF) was conducted.③The latissimus dorsi flaps without excising thoracodorsal nerve or muscle-sparing latissimus dorsi myocutaneous flap were used in 9 cases based on the anatomic study.The flaps with medial branch pedicle were used in three cases and the flaps with lateral branch pedicle were used in six cases.All flaps were with the branches of thoracodorsal nerves.Results①The blood supply of latissmus dorsi,subcutaneous tissue and skin is from various artery such as thoracodorsal artery(TA),musculocutaneous perforator, intercostal artery,lumbar artery.But TA and musculocutaneous perforator are as the main blood supply.②The distance between the crotch of thoracodorsal nerve first class branches and that of nerve fiber is(25.12±3.19)mm.The diameter of initiation part and distance of thoracodorsal artery is(2.32±0.15)mm and(56.75±4.99)mm.The diameter of initiation part and distance of thoracodorsal nerve is(2.14±0.29)mm and(61.22±8.51)mm.The distance longissimus between thoracodorsal nerve and thoracodorsal artery or their branchs is(2.98±0.08)mm.The intramuscular course of the perforators is(42.78±13.24)mm.The thickness of the latissimus dorsi is (4.15±1.24)mm.The distance of level projection is(42.55±13.28)mm.③Sixty -four musculocutaneous perforators were selected in 16 specimens(32 sides) for microdissection.Their external diameters were all larger than 0.5mm.④Four flaps for transplanting and five flaps for anastomosis were survival completely,and the appearance of the reserved muscles was fine,and the function of the articulatio humeri was not different compared with pro-operation such as endoduction,adtorsion.Conclusion①The first branch of thoracodorsal artery and thoracodrsal nerve can be dissected and transferred.The function of the left muscle is not influenced.②With the thoracodorsal artery perforator flap the donor sacrifice is minimal.③As harvesting latissimus dorsi flap without excision thoracodrsal nerve or muscle-sparing latissimus dorsi myocutaneous flap can be excised ranly according to the defect.The function loss of latissimus dorsi muscle can be reduced when this method is used,and it is a good method for repairing a large area defect.